DR Medhat MRCP

III. Radioiodine treatment
It destroys the overactive thyroid tissue.
Indications :
- Toxic multinodular goiter.
- Toxic adenoma (plummer`s disease).
- Relapsed Grave`s disease (or failed ATD): (DC carbimazole 5-7 days before
giving radioiodine to allow uptake of the isotope).
- Grave`s disease in elderly with cardiac disease.
Contraindications include
- Pregnancy (which should be avoided for 4-6 months following treatment).
- Age < 16 years.
- Thyroid eye disease is a relative contraindication, as it worsen the condition
SE : Hypothyroidism (most of the patients will require Eltroxin after 5 years of TTT)
Worsening of thyroid eye disease (15%), so give prednisone with or 3 months
after starting radio-iodine treatment to decrease this risk
IV. Surgery (subtotal thyroidectomy) (usually not the 1 st line of ttt) indicated if :
1. Toxic multinodular goiter,toxic adenoma(not responding to radioiodine)
2. Grave`s disease if failed or allergy to medical ttt .
3. Huge goiter,Retrosternal goiter with compression symptoms.
5. Suspected malignancy.
V. Treatment of thyroid storm (emergency) :
Symptomatic treatment e.g. paracetamol
Treatment of underlying precipitating event
Anti-thyroid drugs: e.g. methimazole or propylthiouracil
Lugol’s iodine
Dexamethasone - e.g. 4mg IV qds - blocks the conversion of T4 to T3
Propranolol
VI. Treatment of thyroid eye disease :
Topical lubricants may be needed to help prevent corneal inflammation.
Steroids
Radiotherapy
Surgery
Prevention
‣ Stop smoking is the most important modifiable risk factor to prevent the
سؤال مهم جدا disease. development of thyroid eye
Follw up investigation to assess the response of ttt of thyrotoxicosis :
- The answer the MRCP exam. is looking for is TSH.